It is now eight months since the first interviews and a year or more since the first consultants were hired and the downsizing was announced by Dr. Maggiano. Many of the trends noted in the introduction toPart IIIcontinue. In particular, refilling open positions is still a slow but improved process. When supervisors or managers leave, the positions are now often not requested to be refilled (in anticipation of flattening and reorganization), which for at least one area left forty employees without an immediate supervisor.

The new consulting company has proceeded to go to work and many large committees (thirty to fifty members) with diverse membership have been developed to examine hospital operations. No significant changes have been made as a result of the product of this work; however, as will be observed in the interviews, a general concern has developed that some key people have been excluded from participation in the committees while others, who are less experienced, have been included.

The new Hospital Director and Vice Provost started work in July. Many of the interviews were completed prior to their arrival.

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